OBJECTIVE: To explore maternal near miss and death after emergency cesarean delivery in Somaliland, including the impact of the prerequisite for family consent.

METHODS: A facility-based, mixed-methods study was conducted to assess all maternal near misses and deaths recorded at a referral hospital that provided services to women from all regions of Somaliland. The data sources comprised a quantitative prospective cross-sectional study using the WHO near-miss tool (performed from August 1 to December 31, 2015) and qualitative interviews with 17 healthcare providers working at the referral hospital who were in direct contact with the women in labor (performed from January 15 to March 15, 2015).

RESULTS: Of the 138 maternal near misses and deaths recorded, 50 (36%) were associated with emergency cesarean delivery. The most frequent maternal complication was severe pre-eclampsia (n=17; 34%), and the most frequent underlying causes were hypertensive disorders (n=31; 62%) and obstetric hemorrhage (n=15; 30%). Healthcare providers were often prevented from performing emergency cesarean delivery until the required consent had been received from the woman's extended family.

CONCLUSION: Maternity care in Somaliland must be improved, and the issue of legal authority for consent examined, to ensure both safe and timely provision of emergency cesarean delivery. This article is protected by copyright. All rights reserved.

Aim: The aim of this literature review was to, from a patient point of view, identify factors within the specialized palliative care that constituted good care from the.Method: A systematic literature review was undertaken. Fifteen articles were reviewed. Thirteen of these were qualitative and two were quantitative.Results: Four categories were identified: self determination, capability of the nurse, nursing relations and maintaining dignity.The patients self determination was a central part of nursing. Delegating control and self determination from a patient to a nurse is also a form of self determination.Capable nurses instill trust and gave patients the opportunity of more alternatives when it came to choices concerning the care of the patient.A good relation with the nurse could give the patient a feeling of being important and being a part of something bigger, despite lack of family or friends. Important factors regarding patient-nurse relations were continuity and nurse accessibility.Maintaining dignity included being seen as the human being that the patient was before the terminal illness was diagnosed.Conclusion: Patients noted several factors as important for good palliative care. These could be summarized as self determination, nurse capability, nursing relations and maintaining dignity.

Suicides by drowning have received limited attention by researchers. A recent finding that almost one-third of all drowning deaths in Sweden were classified as suicide instigated this study. We identified 129 cases of suicide by drowning in Northern Sweden and analyzed the circumstances and the psychiatric history prior to the suicide. Information was obtained from autopsy, police and medical records, as well as from the National Inpatient Register. One-third of the suicide victims had previously attempted suicide and half of the victims had been hospitalized due to mental health problems. One-third of these had left the hospital less than one week before the suicide. Alcohol and psychoactive drugs were present in 16% and 62% of the cases, respectively. A history of mental disorder and previous suicide attempt (s), especially by drowning, is an ominous combination necessitating efficient clinical identification, treatment and follow-up if a complete suicide is to be prevented.

Background: Pain is a major problem in nursing homes. Dementia is a disease that causes humans lose their ability to communicate their pain to their surroundings. People with dementia express their pain through behavioral changes because they can’t verbalize their pain experiences. As a consequence of this leads to that dementia patients are not receiving adequate pain management.

Aim: The aim of this study is to explore how nurses identify pain in dementia patients in nursing homes.

Method: The study was conducted as a literature survey. In total, 15 articles were used in this study that consists of both quantitative and qualitative approaches. Articles have been sought in the databases Cinhal and PubMed.

Results: The results of this study shows that according to nurses is pain identification among dementia patients an extreme challenge and requires more knowledge. Patients with mild to moderate dementia can self-report their pain to a certain extent. The most useful clues to discovering pain among dementia patients who are limited in their speaking skills is to observe facial expressions, body language and behavior changes.

Conclusion: The authors conclude that it is important to create and develop a relationship between caregivers and demented patients. This is to get to know the patient and knowing his usual habits and behavior changes as to facilitate the identification of pain

12.

Akhter, Halima

et al.

Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.

Akter, Dalia

Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.

Extensive demands are placed on midwives in their professional role. The midwifery education is obligated to answer to these professional requirements. ountry specific, feasible and acceptable accreditation toolkit for institution/collages/universities is, therefore, relevant to develop.

Objective:

The objective was to map the existing situation of the midwifery education sites in Dhaka division and to explore acceptable and feasible requirements to be included in an accreditation toolkit for Bangladesh.

Methods:

A questionnaire study with open and closed response alternatives was used.

Results

: Six nursing diploma institute and one nursing college were included in the mapping. The theory in relation to practice (theory/practice) in the education was 40%/60% for 5 institution/colleges and 50%/50% for one institute. Both qualitative open questions and closed questions based on ICM Global standards revealed that the acceptable and feasible requirements for a nationwide accreditation tool for midwifery educations needs clearly written admission and student policies, supportive staffs and formally prepared and globally oriented competent unbiased teachers who maintain their standard by participating in professional development activities.

Conclusion:

Implementing globally standard accreditation tool for educating and training competent midwives is not a far-fetched idea in the context of Bangladesh. The clinical applicability of this essay lies in the fact that competent midwives can profoundly provide suggestions for improvements of midwifery educations with support of an accreditation tool.

13.

Akhter, Shirina

et al.

Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.

Begum, Momtaz

Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.

Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is achieved through the use of contraceptive methods and the treatment of infertility. It secures the well-being and autonomy of women while supporting the health and development of the communities. A midwife can support people having family planning facilities and thus reduce maternal and neonatal mortality and morbidity and unnecessary interventions, and improve psychosocial and public health.

Objective:

The objective of the study was to assess the knowledge, attitudes, and perceptions towards family planning among future midwives in Bangladesh.

Methods:

A cross-sectional study was conducted among final year midwifery students (n=141) of 16 public midwifery nursing institutes and colleges of Bangladesh. A structured questionnaire was used and data analyzed by descriptive statistics in Excel.

Results:

Almost all respondents agreed on the statement that women should be treated with respect when seeking family planning services. One third disagreed or strongly disagreed that unmarried women should abstain rather than use family planning. Almost half of the respondents disagreed or strongly disagreed that women should be free to choose if and when they want to become a pregnant. Majority of the respondents had inadequate knowledge about effectiveness regarding different FP methods and misconceptions regarding hormonal family planning methods.

Conclusion:

This study showed that diverse attitudes related to family planning and women’s right to access family planning services exist among future midwives. The study also found misconceptions regarding side effects of family planning methods and inadequate knowledge regarding effectiveness and appropriateness of different family planning methods.

Clinical implications:

To increase knowledge, midwifery curriculum should have a special emphasis on the effectiveness of different contraceptive methods and effects of hormonal contraceptives, and particularly the link to clinical practice. Value clarification training can be a way to address attitudes in relation to family planning. Further qualitative research should be conducted to gain a deeper understanding of midwifery students’ attitudes and perceptions.

14.

Aktar, Renoara

et al.

Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.

Yesmin, Syeada

Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.

High demands are placed on midwives in their professional role. The midwifery education is obligated to answer to these professional requirements. Country specific, feasible and acceptable requirement accreditation toolkit for institution/collages/universities to achieve is therefore relevant to develop. This study is part of a survey mapping 25 midwifery education sites in seven divisions in Bangladesh. This is to provide a baseline assessment for possible requirement for the ongoing development of an accreditation toolkit for institutes and collages providing midwifery education.

Objective:

The objective was twofold. First, to map five midwifery education sites in Dhaka and Mymensingh divisions as a baseline in the process of developing an accreditation toolkit in Bangladesh. Secondly, to explore nursing instructors’ suggestions of acceptable and feasible requirements for an accreditation toolkit for midwifery education in Bangladesh.

Methods:

The design was a questionnaire study. The total number of participants was 36. Data was collected through a semi-structured questionnaire with both open and closed response options, which were analyzed through essentially non-parametric statistics and systematic text condensation.

Results

: The mapping showed that the students enrolled at the midwifery programs were young, being lectured by comparably few faculty members compared to the number of students, a faculty with an extensive experience of nursing but with less experience in midwifery. Suggestions for the development of an accreditation toolkit were that the assessor should be Bangladeshi, and that posts for clinical teachers and mentors should be one assessment criteria. Further findings showed that 40 normal births were less important to achieve in core competences for midwifery students than other requirements related to midwifery skills.

Conclusion:

An accreditation tool can" close the gap" between the curricula in text and implementation of the same. Mapping of existing education sites amongst partners provides a potential for development of a Bangladeshi national and a global midwifery education accreditation toolkit. The clinical applicability of this essay lies in a development of an accreditation tool that can support institutes to achieve the goal that a Midwifery Diploma curriculum is being implemented that support student’s learning, and the goal that the students will become "Midwives" according to global standards and ICM definition.

15.

Akum, Bertha

et al.

Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.

Rusu, Violeta

Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.

The aim of this study was to evaluate tracking performance when an extra reference block is added to a basic block-matching method, where the two reference blocks originate from two consecutive ultrasound frames. The use of an extra reference block was evaluated for two putative benefits: (i) an increase in tracking performance while maintaining the size of the reference blocks, evaluated using in silico and phantom cine loops; (ii) a reduction in the size of the reference blocks while maintaining the tracking performance, evaluated using in vivo cine loops of the common carotid artery where the longitudinal movement of the wall was estimated. The results indicated that tracking accuracy improved (mean - 48%, p<0.005 [in silico]; mean - 43%, p<0.01 [phantom]), and there was a reduction in size of the reference blocks while maintaining tracking performance (mean - 19%, p<0.01 [in vivo]). This novel method will facilitate further exploration of the longitudinal movement of the arterial wall.

The aim of this study is to analyze if the precision of a shot and a pass differs between professional youth players (16-18 years) and senior players (22+ or older).

Method

A total of 30 elite players which were 16 males and 14 females performed tests in shooting and passing precision. The set-up on the test days were a total of 60 shots(30 lying still and 30 half volley) and 80 passes (20 lying still best foot, 20 rolling best foot, 20 lying still next best foot and 20 rolling next best foot). The test results were analyzed using Excel and Kinovea. In these programs the mean value and standard deviation for each player and test group could be calculated.

Results

The result shows that there were only significant differences in one of six parts regarding precision on the men's side. On the women's side, there was no significant difference in any of the six moments.

Conclusions

The authors of this study identified a plateau between players aged 16-18 and senior players in terms of accuracy in passing and shooting. Players between the ages of 16-18 is as good as a senior player at the individual skills passing and shooting. This plateau can be the result of too little individual training so called isolated training in terms of precision. If the club coaches follow the training SvFF educate, only two minutes per training session goes to each individual skill (SvFF names 13 skills). The lack of time for these skills can be a decisive factor for why the development of precision stands still today.

Background: Diabetes is a major worldwide public health problem and the number of affected people will increase substantially in the next 10-15 years. Early efforts should be made as instructions inself-care and lifestyle changes to prevent the development of complications. Purpose: The purpose is to describe diabetic nurse's training of self-care in patients with type 2 diabetes. Method: The study was conducted as an empirical study with a qualitative approach in which ten diabetic nurses were interviewed. The interview guide included semi-structured questions and the data were processed using qualitative content analysis. Results: Diabetes Nurse's Role in the teaching of patient self-care is to be supportive and provide the patient a sense of confident as many patients are unmotivated to change their lifestyle. The first theme that emerged were diabetic nurse's role to sensitize the patient's self-care responsibilities and it consisted of four categories that she/he will serve as an advisor. However, due to lack of personal, insufficient contact time with the patients can lead to deficiencies in quality of the medical care. Diabetes nurse can use National Diabetes Register for competence development or as guidelines in teaching. Second theme that emerged was the need for education in diabetic patients and consisted of four categories in which the diabetes nurses adapt the teaching to the level of individual skills of the patient inorder to make the patient aware of healthier lifestyles. The patient requires motivation for lifestyle changes as well as to participate in group work sessions on the subject. Conclusion: Diabetes Nurse was trying to teach self-care, adapted to the patient's level of expertise. However, increased resources, i.e. increased number of nurses, and is required to conduct education in diabetes care in accordance with the guidelines. The diabetes nurses require more time to keep up with the latest research performed in the subject diabetes.

25.

Andersson, Camilla

et al.

Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.

Tranlund, Cecilia

Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.

Background: Higher physical capacity is correlated with increased health. Knowledge in this area regarding psychiatric diseases is sparse.

Purpose: The aim was to study aerobic and several strength capacities in a physical activity project for persons with depression or anxiety.

Methods: Eighty-four persons (56 women and 28 men) with depression or anxiety were recruited from psychiatric out-patient clinics in Stockholm. Their mean age and BMI was 46 (21-80) years and 26 (17-41) kg/m2, respectively. 50% were sick-listed. 50% had BMI>25. Aerobic and strength tests were chosen by each subgroup´s project leaders. Directed physical activity was given, in groups 10-15, 1 hour twice/week during 8-12 weeks.

Results: Significant changes (p<0.05, of all n=84) between pre- and post tests were seen in submaximal cycle test (11% enhanced values, n=56) and distance of 6 minutes walk test (16%, n=15) as well as in strength tests for the back for the back (i.e. time in static horizontal belly-back, 40%, n=44), abdominal and hip flexors (i.e. number of hip flexionsit-ups, 45%, n=38), leg (i.e. standing with 90O in hips and knees, 48%, n=56) and arm with shoulder muscles (i.e. number of raising weights alternately with the arms, 46%, n=32). Hand grip tests, BMI or blood pressure values did not change significantly.

Aim: The aim was to investigate the quality of life experience within patients with chemotherapy-treatment.

Methods: The study was conducted as a literature review. Twelve articles were included with 7 qualitative approach and 5 with quantitative approach. Article was searched for in the database CINAHL.

Results: The quality of life experience within patients’ undergoing chemotherapy were compiled from five different categories - Side effects from chemotherapy, the social experience, the physical and cognitive experience, then mental and emotional experience and the need for information and advice. The result shows that the experience of side effects within patients undergoing chemotherapy affected the quality of life negatively. The nurse can help improve the quality of life experience within patients undergoing chemotherapy by adequate information and advice.

Conclusion: Information about potential side effects of chemotherapy is an important part of caring. The prevention work on anxiety and to advise patients to socializing with family and friends can contribute to improving the experience of quality of life within patients suffer from chemotherapy treatment.

32.

Andersson, Jessica

et al.

Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.

Andersson, Mirja

Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.

At the end of life, the nurse's goal is to improve the quality of life for patients with incurable disease or injury. The nurse with a nursing responsibility plays an important and central role and meets palliative patients in all health care departments in a hospital. One of the most challenging experiences might be providing care to a patient in the final phase of life, and one of the biggest difficulties may be to talk about death and sorrow. It is therefore of great importance to study how nurses experience caring for palliative patients in hospital awards.

Aim:

The purpose of the study is to describe nurses' experiences of caring for palliative patients at general hospitals.

Method:

This study was conducted as a literature study and 13 articles were included in the results. The studies had both qualitative and quantitative approach.

Result:

The results show that nurses have varied experiences of caring for palliative patients. Experience of inadequacy and stress is something that most nurses have in common, and it is important when patient needs and wishes can be met. More education is something that is considered necessary if you want to work with palliative care, and areas such as communication, pain and emotional support are considered desirable. Nurses also considered that a hospice is a better suited place for patients to spend their last time in life.

Conclusion:

Nurses working with palliative patients consider it to be stressful and difficult many times since they do not always have sufficient knowledge.

33.

Andersson, Katrin

et al.

Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.

Background: Deliberate self-harm is a symptom of mental illness that ever since the turn of the millennium has been increasingly highlighted. The first contact with healthcare a person with deliberate self-harm often takes place via the somatic emergency medical care. Patients testify to negative experiences in the meeting with these care instances. Therefore, it may be useful to investigate how nurses perceive the meeting with patients with deliberate self-harm. Aim: The aim of the literature review was to describe nurses’ experiences of meeting patients with deliberate self-harm in somatic emergency medical care. Method: The study was conducted as a literature review where 15 scientific articles were sought via the databases PubMed, CINAHL, PsycINFO and Web of Science. The articles were quality-reviewed, analyzed and compiled into a result. Results: In the process of describing nurses’ experiences, three main categories emerged which were: The nurse's thoughts and feelings; Competence and knowledge; Factors that affect the meeting and care. Conclusion: The result showed that nurses in somatic emergency medical care had both positive and negative experiences in the meeting with patients with deliberate self-harm which evoked different feelings and thoughts among nurses. Common to the studies was that nurses stated that they had a lack of competence and knowledge about this patient group.

One percent of Sweden’s population suffers from venous leg ulcers. The risk of recurrence is high at a 70 % recurrence rate. The compliance to performing recommended self-care activities is often low.

The aim of this study was to highlight evidence based self-care activities, and what factors that influenced the adherence to follow the recommended self-care activities in order to minimize the risk of recurrence in patients with venous leg ulcers. The Method was a literature study based on 15 research articles. The result showed that wearing compression hosiery, performing leg exercises, physical activity and resting with the legs elevated was evidence based methods that lowers the risk of recurrence of venous leg ulcers. Factors found that influenced the compliance to self-care activities among patients with venous leg ulcers were: Information, trust, pain, body image, depression, self-efficacy and restricted mobility. The conclusion was that recommending individualized evidence-based self-care activities to patients with on-going or previous venous leg ulcers lowers the risk of recurrence. A trusting relationship should be established between the nurse and the patient, and interventions aimed towards increasing the patient compliance to recommended self-care activities should be prioritized. By adapting a preventive approach in order to decrease recurrences of venous leg ulcers, the suffering of the patients are minimized as well as the health-care costs of society.

41.

Andersson, Maria

Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.

Background: Diabetes mellitus type 2 is a disease that is increasing in the population worldwide. The disease can cause severe complications that affect patient health. An important part is to change unhealthy habits. Purpose: The aim was to describe the district nurse's experience of how they motivate patients with type 2 diabetes to lifestyle changes. Method: A qualitative approach with semistructured interviews were conducted and five district nurses were interviewed. The material was analyzed according to Graneheim and Lund's content analysis. Results: The study revealed that it was important that the district nurse created a good relationship with the patient to motivate lifestyle changes. Study participants highlighted the importance of support in the patient's environment by involving family and other patients. It also emerged that the participants motivated by being a good teacher and to work with other professionals. Personalized information and different kinds of pedagogical methods were used to increase the patient's motivation. Conclusion: To be able to motivate their patients to lifestyle changes the district nurse must provide information individually to their patients which can be done through various teaching methods. It´s also important to create a good relationship with their patients by establish trust.

Background: Heart failure is a common and serious condition with high mortality rate, morbidity and impaired quality of life. It is estimated that about a quarter of a million Swedish people have chronic heart failure. The creation of a specialist nurse-led heart failure clinic with medical assistance has improved the treatment of patients with heart failure.

Aim: The aim of this study was to examine patients’ perceptions of the factors that are important in the care on specialist nurse-led heart failure clinics.

Method: Interviews with semi- structured questions were used. A qualitative manifest content analysis was used to analyze the material found during the interviews. The informants were selected through a strategic selection.

Results: The result showed that a functional relationship between patient and specially trained nurses at the heart failure clinic, and sufficient information to manage their own care, was of the most importance to the patients. A good healthcare relationship are described by the patients as containing continuity, trust to the nurse, friendly treatment, cooperation’s with healthcare staff and availability as needed.

Conclusion: The care of a specialist nurse-led heart failure clinics are important for patient safety. It seems important to know whom heart failure patients should contact if necessary help and support to deal with their situation. To have the ability to contact a nurse when needed was very meaningful. The informants found the information on how to handling their own care as important and as a support in their daily life.

Supporting the woman and her partner is a major part of the midwifery role during delivery. As the number of newly arrived women increases in Sweden, with varied backgrounds and languages, the demands on midwives’ skills increase. Both migration and childbirth can be described as transitions, which can lead to positive development but also to increased challenges. Migration can be a stressful life process for newly arrived woman and the situation of childbirth can contribute to further vulnerability and uncertainty. The midwife has to understand the needs of newly arrived women in order to support and contribute to a positive experience.

Aim:

The aim of this study is to describe midwives' experiences and strategies in the meeting with newly arrived women at childbirth, focusing on interaction, trust and context.

The results of the study provided information on strategies that the midwives use to create interaction, trust and context, as well as their experiences. Common to all midwives was that they experienced that good communication with the patient was very important for creating interaction. Ahead of the meeting with a newly arrived woman, the midwives made sure of that they were well prepared. Strategies used to create trust were to show consideration, be present and take time to listen to the woman. By listening to the woman's wishes, providing information and trying to make the woman feel active and making active choices during her childbirth, midwife creates a context for the woman.

Conclusion:

The study has shown that midwives have conscious strategies for meetings with immigrated women. There is, however, a need for clearer routines

regarding the work of immigrated women in the delivery room, increased cultural skills of midwives and more resources to allow more time for these women.

Clinical application:

This study, through the strategies of midwives, can guide other midwives to support newly arrived women during childbirth. The study provides suggestions for areas of improvement and aids to improve the meeting and hence the quality of care for these women.

48.

Anderstedt, Chatrine

Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.

With the purpose of getting an overview of the current research and development in information systems and terminology for nursing practice and outline strategies for the future, an initiative for a workshop was taken at the national level in Sweden by the Section for Nursing Informatics, the Society of Nursing and the Association of Health Professionals in 2007. For the workshop around 30 nurses were invited, representing clinical practice, education, and research. The workshop resulted in recommendations for future strategies to support the development of nursing informatics in Sweden.